Before I even begin typing all of the things that are running through my head, I have to acknowledge a couple of things:
-I was lucky enough to have the complete support of my family as VBAC hopefuls.
-I was lucky enough to have access to a care provider and birth location that were supportive of our goals to VBAC.
-I was lucky enough to avoid conditions that would risk me out of TOLAC.
I recognize that these are not givens for every family and that many of the cards were stacked in our favor here. But this post is just a couple of reflections on my experience and maybe how it’s shaped my view as a mom and doula.
1. I was scared….really scared. But of what? I wasn't scared that my uterus would blow up. I wasn't scared that my baby would die. I wasn't scared that my care provider would bait and switch me. I was scared that for whatever reason, my VBAC wouldn't be successful and that I would have to face family, friends and colleagues. While everyone was outright supportive, I knew there were some people who thought we were a little nuts and I didn't want to have to hear any “I told you so’s”. It’s probably the silliest thing in the world to be afraid of, but it’s true…this was my hang up…
2. I was determined. Really determined. Not in a bullheaded way, just in an “I’m doing this!” kind of way. Knowing that I was open to the idea of more kids in the future, I viewed this as a critical turning point in our reproductive future. For anyone who may not be familiar with the research on the complications associated with cesarean sections, the most important thing to know is that the risk of many obstetrical complications increases with every cesarean. For example, the risk of placenta accreta in a first cesarean is about 0.24%, or one in 417 women; in a second cesarean, this increases to 0.31% or one in every 323 women; but by the 4th cesarean, the risk jumps to 2.13% or one in every 47 women! ICAN, the International Cesarean Network, is a fantastic resource for this kind of information, as is VBACFacts.
3. I was confident. Maybe a little overly confident? I didn't see any reason why I couldn't do it. It just seemed logical to me that humans can birth humans without surgical intervention. To be honest, I didn't even say I was having a VBAC, I was just planning a vaginal birth- no qualification of “after cesarean” even entered my mind.
4. I wasn't ready for a battle. I didn't know every statistic, every study. I don’t even think I knew that I should stay away from Pitocin. There is no way I could have engaged in an intellectual discussion with my care provider about these things. Luckily, I didn't need to. But if I had to do it again, I’d be better armed to speak intelligently about my reservations and to propose alternatives that may help us compromise on care that we are both comfortable with.
5. I didn't have any labor support. I’m a professional doula, so this isn't easy for me to say, but you don’t *need* anyone there to achieve your VBAC. To say that you must have someone there to advocate for you takes power away from you. Don’t make anyone else’s presence a prerequisite for VBAC success. (As a side note, our doula practice has a 97% VBAC success rate across the last 5 years, which is significantly ahead of the national and even local average!)
6. A little help is ok. Some people think that the only way to achieve VBAC is to go completely natural with absolutely no medical intervention. That’s a great way to do it, but it’s not the only way. A little help can remain just that…a little help. Having fetal monitoring or a little pitocin or even an epidural aren't going to completely kibosh your VBAC dreams. All things in moderation, though. Be careful of the “cascade of interventions”, but recognize your needs in the moment and be kind to yourself.
7. It was as awesome as I thought it would be. No, I don’t think that a woman should be defined by any biological process…we don’t take joys in any other of them…but there is something to be said for making a plan, working hard to accomplish it, and achieving it!
8. I understand completely why some families chose a repeat cesarean. The decision was really easy for us, but I can see why it might not be such a clear cut choice for every family. There’s politics, there’s conflicting information about the safety, there’s “policy wars”, insurance concerns, the hunt for a supportive provider, fears about the unknown… And all of this when you’re literally trying to grow a human.
9. No amount of preparation can guarantee VBAC success. Just like cesareans are sometimes 100% indicated in a first birth, the same holds true in a second or later birth. You can read every book on child birth, have all the research under your belt for preparing a safe VBAC, have an awesomely supportive provider, be accompanied by a fantastic doula, have the baby’s father on your side 100% of the way, (insert all the other things you think are necessary to achieve a vaginal birth), and things still may not work out as planned. Refresh your knowledge of when a cesarean is indicated. Know which ones are immediate emergencies, and which ones you may be able to work to reverse or manage. This will help you to feel comfortable in the event that it is no longer safe to continue a trial of labor.
I have absolutely no regrets about my VBAC - well, except for the tragic song he had to be born to. It wasn't a short or easy labor; early labor began on Monday and didn't end until just after Wednesday turned into Thursday. After 50+ hours of intense but tolerable labor, my sister finally convinced me to go to the hospital as I was throwing up on my bathroom floor. I had been denying it was time to have the baby, despite his being many days (dare I say "weeks") past his estimated due date. From the time I got to the hospital to baby napping in my arms was 3 hours, and my Thanksgiving baby and I have been inseparable since.
End note: For those of your reading from Eastern PA, we are also lucky to be living in an area that is becoming more supportive of VBAC, even VBA2C, VBAmC and special scar situations. When I had my VBAC, this wasn't the case and I was simply lucky to have had a care provider that was one of the few really supportive people in the area. If you need information on VBAC supportive providers, we are happy to point you in the right direction!